Nutritional Diagnosis Research Articles

A Cross-Sectional Validation Study of Camry EH101 versus JAMAR Plus Handheld Dynamometers in Colorectal Cancer Patients and Their Correlations with Bioelectrical Impedance and Nutritional Status.

Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited by the cost of the reference device (JAMAR). A cross-sectional study was conducted on colorectal cancer outpatients treated with chemotherapy or under active surveillance in our center from September 2022 to July 2023. Accuracy, reliability, and concordance were compared for two handheld dynamometers: the JAMAR Plus (the gold-standard device) and the Camry EH101 (a low-cost index device). A simultaneous nutritional diagnosis with GLIM criteria and bioelectrical impedance analysis (BIA) was carried out. A total of 134 participants were included. The median of maximal strength for the JAMAR Plus had a non-significant difference of 1.4 kg from the Camry EH101. The accuracy and reliability of the devices were high. Bland-Altman analysis showed a 0.8 kg bias and -4.1 to 5.6 kg limits of agreement (LoA); a 0.1 kg bias and -5.3 to 5.4 kg LoA in men; a 1.5 kg bias and -2.2 to 5.3 kg LoA in women. In total, 29.85% of the participants were malnourished. Prevalence of dynapenia increased from 3.67% with the JAMAR Plus to 5.14% with the Camry EH101. Both devices had a moderate and significant correlation with BIA-estimated muscle mass. The Camry EH101 was a cost-effective alternative to JAMAR Plus in our sample.

Improved long-term outcome of children with congenital diarrhea followed by an intestinal rehabilitation program.

Long-term outcomes of congenital diarrheas and enteropathies (CODE) are poorly described. We evaluated the morbidity and mortality of children with CODE followed by an intestinal rehabilitation program (IRP) compared to children with short bowel syndrome (SBS). Matched case-control study of children with intestinal failure (IF) due to CODE (diagnosed between 2006 and 2020; N = 15) and SBS (N = 42), matched 1:3, based on age at diagnosis and duration of parenteral nutrition (PN). Nutritional status, growth, and IF-related complications were compared. Survival and enteral autonomy were compared to a nonmatched SBS cohort (N = 177). Fifteen CODE patients (five males, median age 3.2years) were followed for a median of 2.9years. Eleven children were alive at the end of the follow-up, and two achieved enteral autonomy. The CODE group had higher median PN fluid and calorie requirements than their matched SBS controls at the end of the follow-up (83 vs. 45 mL/kg/day, p = 0.01; 54 vs. 30.5 kcal/kg/day, p < 0.01), but had similar rates of growth parameters, intestinal failure associated liver disease, central venous catheter complications and nephrocalcinosis. Kaplan-Meier analyses of 10-year survival and enteral autonomy were significantly lower in CODE patients compared to the nonmatched SBS population (60% vs. 89% and 30% vs. 87%, respectively; log-rank p < 0.008). Despite higher PN needs in CODE, rates of IF complications were similar to matched children with SBS. Enteral autonomy and survival rates were lower in CODE patients. Treatment by IRP can mitigate IF-relatedcomplications and improve CODE patient's outcome.

Adaptation and Validation of the S-NutLit Scale to Assess Nutritional Literacy in the Peruvian Population.

Maintaining good dietary practices is a factor that allows a better quality of life; therefore, it is necessary to promote health via the fundamental tool of nutritional literacy. In this context, this study aims to evaluate nutritional literacy in Peru through the S-NutLit tool, which is composed of two dimensions. The scale, composed of 11 items, was applied to 396 Peruvian adults. According to the evaluation of the indicators, an acceptable reliability was found, as was a model fit with excellent estimation according to its indicators (CMIN/DIF 2.559; IFC 0.965; SRMR 0.043; RMSEA 0.063; and PClose 0.070). In this way, we seek to reinforce health promotion activities through a nutritional literacy diagnosis, which, due to its characteristics, can be self-administered and used by health entities and other entities in general that are interested in knowing the eating practices of an individual, which undoubtedly leads to good health.

Relationships between nutrients in the soil and nutritional status of Pinus taeda stands in southern Brazil

The characterization of nutrients availability in the soil and its relationship with nutritional status and productivity of Pinus taeda stands in southern Brazil is still of concern due the lack of research on this subject. We compared different methods to evaluate P, K, Ca, and Mg in the soil and in plant tissues. We performed the evaluations in six paired plots (control and fertilized) located on different soils conditions in southern Brazil. Availability of nutrients in the soil was obtained after extractions of soil solutions with the extractors Mehlich I (P, K), KCl 1 mol L−1 (Ca, Mg), and 1 % citric acid (P, K, Ca, Mg). Foliar and wood samples were collected to determine the P, K, Ca, and Mg contents in the trees’ tissues. The mean annual increment (MAI) of each plot was obtained from the annual inventories of the P. taeda stands. The contents of P, K, Ca, and Mg in the soil followed similar trends for the different extractors tested, with higher contents of Ca and Mg in the fertilized plots. No differences for P and K in the soil were observed between control and fertilized plots for both methods applied. The fertilized plots showed increase for Ca and Mg in the wood tissues but not in the needles. Positive correlation between wood and needle tissues was observed only for the P content. No correlation between the nutrient contents in the needles and in the soil was observed. But we found a positive correlation between the nutrient contents in the wood and in the soil, mainly for the 1% citric acid method. No correlation was found between the nutrients in the plant tissues and the productivity of Pinus taeda. Our results improved the knowledge concerning the nutrient dynamics in P. taeda stands in southern Brazil showing that citric acid is a good extractor for P, K, Ca, and Mg in the soil, and that determination of nutrients in the wood tissues is a potential method for nutritional diagnosis of P. taeda.

Nutritional diagnosis of soursop according to the Kenworthy balance index and deviation from optimum percentage, Nayarit, Mexico

Soursop is a tropical fruit of economic importance in Mexico, however, there is scarce research on its nutrition. The aim of this study was to evaluate the foliar nutrient concentration in the vegetative state and to compare the nutritional diagnosis between the Kenworthy Balance Index (KBI) and Deviation from Optimum Percentage (DOP) in the soursop crop. The foliar concentration of N, P, K, Ca, Mg, Mn and B presented lower values than the reference standard. It was found concordance between KBI and DOP indices for the diagnosis in 91% of the orchards; the nutrients N, P, K, Ca, Mn and B were deficient in all orchards and excessive Cu (in 33% of the orchards), Fe and Zn (in 8% of the orchards respectively). However, the diagnosis of Mg, Fe, Cu and Zn in some orchards was contradictory due their adequate ranges with the KBI and deficient with the DOP. In general, with the two indices 25% of the orchards coincide with the decreasing order of the nutrients P&lt;K&lt;Ca&lt;N&lt;Mg&lt;Mn&lt;B&lt;Zn&lt;Fe&lt;Cu. Although there were some similarities and differences in the nutritional diagnosis among KBI and DOP, the specific nutritional needs of each soursop orchard must be supply.

A reasoning method for rice fertilization strategy based on spatiotemporal knowledge graph

AbstractThe lack of multidimensional knowledge means that current reasoning methods for rice fertilization cannot make decisions accurate when faced with complex spatiotemporal conditions in general. Therefore, we propose a reasoning method for rice fertilization strategy based on spatiotemporal knowledge graph. First, we systematically organize multisource expert knowledge about rice fertilization, and construct an ontology for rice fertilization consisting of five core elements: rice variety, planting environment, nutrition diagnosis, fertilization schemes, and time and place. Spatiotemporal differences in rice fertilization knowledge are expressed by assessing spatiotemporal concepts, relations, and state instances. Second, we propose a reasoning method for rice fertilization strategy based on the constructed knowledge graph. This method leverages a certainty factor model for nutrition diagnosis and integrates case‐based and rule‐based reasoning to determine fertilization schemes for different stages. Finally, taking Pucheng County, China, as an example, knowledge from crowd‐sensing data is obtained to construct a knowledge graph using the proposed method. The results demonstrate the method can support the expression and complex reasoning of rice fertilization decisions under different spatiotemporal conditions.

Prevalence and factors associated with malnutrition on patients with cancer in Bangladesh: a cross-sectional study

IntroductionMalnutrition is related to the development of chronic diseases, including cancer and is a major cause of mortality in patients with cancer. The study aimed to understand the prevalence and...

Construction of individualised care programmes for patients with pancreatic cancer with postoperative weight-loss control based on the Delphi method: a cross-sectional study in China

BackgroundAt present, clinical nutritional care for patients with pancreatic cancer focuses more on the observation of the effect of enteral parenteral nutrition, and there is a lack of personalised care plans for weight-loss control. We used the Delphi method to construct a set of personalised nursing programmes to effectively control the rate of postoperative weight loss in patients with pancreatic cancer.MethodsThis study was a cross-sectional investigation. Through literature analysis, literature review and data review, a personalised nursing plan for the postoperative weight-loss control in patients with pancreatic cancer was preliminarily developed. From October to December 2022, the Delphi method was adopted to conduct two questionnaires for 32 experts working in fields related to pancreatic diseases in Grade-A tertiary hospitals from four different departments. After statistical processing, the personalised nursing plan was determined according to the perceived level of importance, coefficient of variation, full score rate and recognition rate of the indicators.ResultsThe recovery rates of the two rounds of consultation were 93.75% and 100%, respectively, and the overall authority coefficient of the experts was 0.918, which represented ‘authoritative’. In terms of importance, the coefficient of variation was 0–0.137; in terms of feasibility, the coefficient of variation ranged from 0.09 to 0.194. Finally, a scheme consisting of 36 entries in 8 dimensions was built. This programme is comprehensive in content, meets the nutritional diagnosis and treatment needs of patients in the stage of postoperative rehabilitation, provides relatively comprehensive nutritional assessment and support and has a robust system and feasibility.ConclusionsThe individualised nursing plan for patients with pancreatic cancer with postoperative weight-loss control based on the Delphi method is highly scientific and reliable and has positive significance.

Artificial intelligence driven malnutrition diagnostic model for patients with acute abdomen based on GLIM criteria: a cross-sectional research protocol

BackgroundPatients with acute abdomen often experience reduced voluntary intake and a hypermetabolic process, leading to a high occurrence of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly...

Efficient detection of nutrient deficiencies and development of corrections in avocado through the Compositional Nutrient Diagnosis (CND)

Mexico is the main producer of avocado (Persea americana Mill.), contributing 31% of the world supply, which provides the country with an annual income of more than 2 billion dollars. The increase in national production is the result of a larger cultivated area, and not an increase in yields. In the State of Mexico, Mexico around 10 thousand hectares are cultivated with avocado trees, although 77% of the producers do not have specialized technical advice that offers reliable information on crop nutrition. This lack of advice and technical support detracts from volume and quality of production. The objective of this research was to carry out the nutritional diagnosis of an avocado orchard in Tejupilco, State of Mexico, Mexico, through the Compositional Nutrient Diagnosis (CND), and to generate specific fertilization recommendations for the study area, for which leaf and soil analyses were carried out. Each nutrient determined in the leaf analysis (N, P, K, Ca, Mg, S, Fe, Mn, Zn, Cu, and B) was compared with its optimal concentration according to literature. The CND yielded relative deficiency or excess indices that determined the order of nutritional limitation. Zn, B, S, and K deficiencies were detected in all sampled areas, while P, Mn, and Cu were deficient only in some areas. N, Ca, Mg, and Fe did not show nutritional limitation. Recommendations were formulated to address each of the nutritional deficiencies and the problem of sodicity revealed by the soil analysis. This is the first work in which the CND is used to assess the nutritional situation of avocado orchards in the world.

Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study.

The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

ADDUCTOR POLLICIS MUSCLE THICKNESS AS A DIAGNOSTIC TOOL FOR MALNUTRITION IN HOSPITALIZED PATIENTS

Malnutrition causes changes in body composition and compromises the physical and mental functions of individuals. One of its main characteristics is involuntary weight loss, associated with worse health outcomes. In hospital environments, the risk for the condition is high, especially among critical patients, the elderly or those undergoing surgery. This study explores the potential of adductor pollicis muscle thickness (EMAP) as an auxiliary diagnostic tool for detecting malnutrition in hospitalized patients, given its accessibility and low cost. The research involved 100 adult individuals and evaluated the correlations between EMAP, arm circumference (CB) and calf circumference (CP) with the participants body mass index (BMI). Furthermore, it suggested cut-off points for these anthropometric measurements for detecting malnutrition. The results indicated that CB and CP correlated more strongly with BMI compared to EMAP, being more effective choices for nutritional diagnosis. Regarding cutoff points, the values with the highest sensitivity and specificity for diagnosing malnutrition were 12.50 mm for EMAP, 26.00 cm for CB and 30.50 cm for CP, respectively.

Hospimeal: Website Based Nutrition Care Process Digitalization

The nutrition Care Process (NCP) is a systematic approach or standard to provide comprehensive nutritional care for patients or clients. NCP consists of 4 interrelated steps, namely nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring and nutrition evaluation. Implementation of NCP in many health services facilities face some barriers because of using manual NCP, such as human error, time-consuming, and incomplete documentation. Digitalization of NCP has proven to be beneficial in terms of efficiency of time and provision of electronic data to improve patient services. This study aimed to develop Hospimeal as a website-based Nutrition Care Process (NCP). The development of the web-based NCP application carried out in this study used the waterfall method. The stages of the waterfall method are need analysis, study of literature and data retrieval, system requirements, system planning, system implementation and testing, digitalization of NCP management in website. Digitalization of Standardized Nutrition Care Process (NCP) management can be developed in the form of a website called Hospimeal. This website provides nutritional care to patients/clients starting from nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring, and nutrition evaluation. The Hospimeal website can be operated by the relevant nutritionist/dietitian. At the beginning of the display there is a Login menu which can be used by nutrition-ists/dietitians to enter the website

Development of a mobile application to represent food intake in inpatients: dietary data systematization

BackgroundNutritional risk situations related to decreased food intake in the hospital environment hinder nutritional care and increase malnutrition in hospitalized patients and are often associated with increased morbidity and mortality. The objective of this study is to develop and test the reliability and data similarity of a mobile application as a virtual instrument to assess the acceptability and quality of hospital diets for inpatients.MethodsThis intra- and interobserver development and reliability study investigated an in-hospital food intake monitoring application based on a validated instrument for patients with infectious diseases who were treated at the Evandro Chagas National Institute of Infectious Diseases (INI/FIOCRUZ). The instrument was sequentially administered to patients 48 h after admission to INI hospital units using the printed instrument (paper) and the digital application (ARIETI) simultaneously. The tested reliability factor was the consistency of the method in the digital platform, checking whether the application provided equivalent data to the paper instrument, and finally, a statistical analysis plan was performed in the R platform version 4.2.0. This project was authorized by the FIOCRUZ/INI Research Ethics Committee.ResultsThe ARIETI was developed and tested for reliability in 70 participants, showing a similar ability to calculate caloric intake in Kcal, protein intake (g), the proportion of caloric intake and protein intake relative to the prescribed goal. These instrument comparison analyses showed statistical significance (p < 0.001). The application was superior to the paper-based instrument, accelerating the time to perform the nutritional risk diagnosis based on food intake by approximately 250 s (average time).ConclusionsThe ARIETI application has demonstrated equivalent reliability compared to the original instrument. Moreover, it optimized the time between the diagnosis of nutritional risk related to dietary intake and the nutritionist’s decision making, showing an improved ability to maintain information quality compared to the paper-based instrument.

Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital.

The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.

P1087 A retrospective study on the GLIM criteria for assessing malnutrition in patients with Crohn's Disease and its correlation with clinical outcomes

Abstract Background It is a common occurrence for patients with Crohn's disease (CD) to suffer from malnutrition. A novel approach to assessing malnutrition has been devised by the Global Leadership Initiative on Malnutrition (GLIM). Therefore, the objective of this study was to investigate the prevalence of malnutrition in CD patients using GLIM criteria and evaluate the clinical utility of GLIM in this population. Methods A retrospective cohort study was conducted with 386 patients with Crohn's disease. Data were extracted from the medical records, including demographic and clinical characteristics. All patients were evaluated using the nutritional screening and diagnosis criteria of the NRS 2002 and the GLM criteria. The prevalence of malnutrition was reported and the relationship between malnutrition and clinical outcome was analyzed. Results The prevalence of malnutrition among CD patients was 73.6% and 35.1% in mild malnutrition, 35.4% in moderate malnutrition, and 35.4% in severe malnutrition. The majority (143, 50.4%) of malnourished patients were categorized as B2 or B3 phenotype, with a significant difference (P= 0.001). The malnourished group had significantly higher CDAI scores than the non-malnourished group (122.9±70.5 vs. 77.3±61.3, P&amp;lt;0.001). In the primary cohort, patients at risk of malnutrition with inflammatory load exhibited a significantly worse clinical outcome compared to those without inflammatory load (OR 4.07, 1.56-10.7; P=0.004). Conclusion Malnutrition caused by Crohn's disease is a significant issue for numerous patients. Malnutrition identified using the GLIM criteria was found to be associated with CDAI, age, and behavior, providing prognostic value for clinical outcomes.

N04 Impact of phase angle on nutritional assessment and disease activity in patients with Ulcerative Colitis

Abstract Background An increase in the prevalence of Ulcerative Colitis (UC) has been reported, especially in Latin America, malnutrition occurs in up to 70% of patients with active disease. The complete assessment of nutritional status is the best method to make an adequate diagnosis since it considers 4 parameters, anthropometry, biochemistry, clinical, and dietary, however, it is very extensive and there are other methods such as bioelectrical impedance (BIA), which is a non-invasive way to estimate the percentage and amount of fat, muscle, water and phase angle (PhA). Moreover, PhA has been proposed as a marker of cell integrity which may be a substitute for complete nutritional assessment. Therefore, the study aimed to evaluate the effectiveness of PhA in the nutritional diagnosis of patients with UC. Methods A cross-sectional study was carried out in patients with UC and healthy controls. Body composition was measured in both groups to obtain the PhA. U Mann-Whitney test was used to compare the data. Patients were classified according to their PhA, considering a normal value of &amp;gt;6.1° and a low value of &amp;gt;6.1°. Results The study included 60 UC and 120 controls, 65% were women, and 35% men, the PhA was lower in UC compared to the controls, in addition to the fact that patients with active disease had a lower PhA compared to patients with remission (5.6±0.9 vs 6.06±0.8, p&amp;lt;0.05). In our study, patients with a low PhA had a lower amount of weight (Active: 60.5±13.6 vs 70.3±.8, p=0.018, Remission: 57.1±11.4 vs 69.4±8.7, p=0.006), dry lean mass (Active: 13.8±3.6 vs 18.2±.6, p=0.009; Remission: 13.1±2 vs 19.7±5.3, p&amp;lt;0.001), total body water (Active: 27.4±6.2 vs 32.9±4.6, p=0.028; Remission: 25.3±3.8 vs 34.4±9.2, p=0.003), and intracellular water (Active: 51.9±3.2 vs 55.1±3.3, p=0.042; Remission: 49.3±10.7 vs 55.8±3.6, p=0.025 ) regardless of disease activity. In this population, we can observe that the inflammation markers (ESR, CRP) were increased in accordance with the activity of the disease associated with PhA, which is consistent with what has been reported in the literature. Conclusion The PhA is modified in patients with UC compared to healthy patients, even more so when they have active disease. Women with active UC are those at risk of malnutrition and cardiovascular risk measured by PhA and CCI. PhA is effective in diagnosing malnutrition in patients with UC regardless of conventional parameters for evaluating nutritional status (Figure 1).

DRIS standards for identifying yield-limiting nutrients in Khasi Mandarin and their relationship with fruit yield on acidic soil of the eastern Himalayas, India

Mandarin fruits are the most widely grown citrus fruits in the world, particularly in the eastern Himalayas of India, which is the primary center of citrus diversity. Diagnosing potential nutritional imbalances using leaf tissue analysis is a mandatory practice for a higher yield. Regarding the nutritional diagnosis of Khasi mandarin plants, particularly in the acidic soil of the hilly ecology of the Eastern Himalayas, India, there is currently no information available. Therefore, the present study was conducted to identify nutrient constraints, establish leaf-based diagnostic recommended and integrated system (DRIS) norms, and determine nutrients’ relationship with fruit yields in 144 orchards. The result showed that the DRIS indices predicted a nutritional optimum value for Khasi mandarin: 2.26–2.83% N, 0.11–0.16% P, 1.86–2.07% K, 1.85–2.12% Ca, 0.33–0.48% Mg, 170.10–225.10 mg kg−1 Fe, 74.03–83.43 mg kg−1 Mn, 1.24–2.45 mg kg−1 Cu, and 19.84–21.28 mg kg−1 Zn. The DRIS norms identified the nutrients Zn, P, Ca, K, N, and Mg as deficient to low levels (14.15→2.14), while Fe, Mn, and Cu were at high to excessive levels (5.50→18.25). The nutritional balance index had a significantly negative relationship with the fruit yield. Leaf nutrient concentrations of N (0.909**), P (0.827**), K (0.867**), Zn (0.833**), Ca (0.827**), and Mg (0.592**) had a significant positive correlation with fruit yield. The finding will facilitate the correct interpretation of leaf nutrient analysis, and the norms developed will enable a precise intervention through nutrient management for higher yields in mandarin citrus.

What is happening with the clinical nutritionist? Realities and challenges

BackgroundAt hospital level, clinical nutritionists play a fundamental role in health recovery, contributing to shorter hospital stays and addressing hospital malnutrition. However, in Latin America no studies have been conducted on the activities of the nutritionist and the factors influencing their performance. Aims: to describe the activities of the clinical nutritionist in public and private hospital settings in Latin America and to determine the factors associated with disciplinary practice. Methods: A cross-sectional analytical, quantitative study was conducted. Participants consisted of hospital nutritionists from 13 Latin American countries who had participated in a previously validated online survey on the activities performed during their daily work, obtaining a Professional Activities Score (PAS). Results: 1222 nutritionists participated. Of the activities associated with the professional role, the only ones who reached over 75% of execution were: performing nutritional intervention; performing nutritional assessment and diagnosis; providing counseling and dietary prescription; developing nutritional care plans for patients with nutritional problems; and performing the monitoring and evaluation of results of priority patients. The least frequent activities were: university teaching and collaborating in research. Regarding the reasons for not performing activities: 34.0% reported not being included in the activities, 24.5% mentioned lack of time, and 13.6% indicated that the activities were conducted by another professional. Variables positively associated with an increase in the PAS were: having spent more years exercising the profession (Beta: 0.028, 95% CI: 0.004; 0.051), and having a greater number of specialties (4 or more, Beta: 2.294, 95% CI: 1.031; 3.557). Working in lower-complexity facilities (Low: Beta: -1.037, 95% CI: -1.443; -0.630), and having more reasons for not performing the activities (3 or more: Beta: -3.105, 95% CI: -4.111; -2.099) were inversely associated. From the sample, 1.8% held a doctorate in clinical nutrition, 43.9% had a specialty, and 64.4% had a diploma or postgraduate degree in clinical nutrition. ConclusionNone of the activities related to the nutritionist work was performed on a 100% basis. In Latin America, Ministries of Health should standardize and regulate the functions of the clinical nutritionist, as well as quantifying understaffing and proposing solutions to alleviate the shortage of these professionals, acknowledging the positive impact that they have on the recovery of hospital patients.

Revisiting the relationship between nitrogen nutrition index and yield across major species

Crop nitrogen (N) fertilization diagnoses via the N nutrition index (NNI)-yield relationship have been tested for several crop species, but a cross-species comparison of that relationship has not been performed yet. This study aimed to perform a cross-species comparison of the relationship between NNI and yield with emphasis on the yield sensitivity to N deficiency, slope of the models. Additionally, we conducted an evaluation to determine the best NNI sampling moment to predict relative yield, with focus on major grain crops. Based on a recently published global dataset to parametrize critical dilution curves, we calculated integrated NNI, instantaneous NNI, relative yield, and relative shoot biomass for annual ryegrass, tall fescue, maize, potato, rice, and wheat. We obtained 238 observations to fit integrated NNI-relative yield linear mixed-effects models and 1606 observations to fit instantaneous NNI-relative yield models. Subsequently, we performed a sensitivity analysis to determine the best NNI sampling moment to predict relative yield, with focus on major grain crops (maize, rice, and wheat). Our results show that there was low inter-species variation of sensitivity to N deficiency, i.e., the slope of the relationship between relative yield and integrated NNI. For grain crops, instantaneous NNI around anthesis demonstrated a better predictive capability for relative yield, outperforming other vegetative stages. This finding contributed to improving the understanding of the association between relative yield and NNI with implications for breeding programs, nutrient management practices, and crop modelling. Most importantly, this study is a contribution to improving the N nutrition diagnosis for several crop species, by using an integral, comparative approach.